For all the external economic fears worrying countries everywhere, Russia faces further, entirely homegrown challenges. In all likelihood, the most important one among them is public health, which directly undermines the country’s economic development.

During the past two decades, an aging demographic turn and its effect on Russian society has been the focus of debate. Russia is experiencing a rapidly aging population with steadily declining birth rates.

However, while people living in most industrialized countries can count on increased life expectancy, Russians cannot. This reflects their relatively low overall health status.

These factors, in addition to restrictive immigration policies and low fertility rates (below two children per woman, which is considered the population replacement rate), have led Russia to a constant process of depopulation.

Between 1993 and 2015, Russia’s population decreased slightly, from approximately 149 to 144 million people. However, if current trends continue, there will be between 100-107 million Russians in 2050.

Preventable deaths

Serious health problems among Russians derive from high rates of smoking and alcohol consumption. Mortality among Russian men rose by 60% since 1991, four or five times higher than the European average.

According to the World Health Organization, heart disease, aggravated by alcohol and tobacco, is responsible for over 1.2 million deaths each year.

Estimates of annual fatalities derived from smoking-related diseases range from 350,000 to 400,000. In the United States, which has more than twice the population of Russia, cigarette smoking causes more than 480,000 deaths annually.

Public health policies and information about smoking is less easily available in the Russia than in the United States, which may account for the lower percentage of deaths in the United States.

HIV/AIDS still looms large, particularly because 80% of those infected with HIV are under 30. The epidemic is closely associated with high levels of intravenous drug use.

More than two million Russian men are considered to be HIV positive, and the epidemic doesn’t show any signs of abating. In the United States, more than 1.2 million people are living with the infection.

In contrast to Russia, the estimated U.S. incidence (new cases) of HIV has remained stable in recent years due to effective public health policies and prevention efforts.

The hideous drug-resistance challenge

Tuberculosis still affects many Russians. Even more seriously, as in China, the country is experiencing a high burden of multidrug-resistant (MDR) tuberculosis, a variety of the disease impervious to isoniazid and rifampicin, the two most effective first-line anti-TB drugs.

Treatment of MDR TB requires treatment with drugs that are less potent and more toxic that those used to treat drug-susceptible TB.

The prevalence of diabetes is also increasing rapidly in Russia. Four million people have been diagnosed with the disease — and almost six million people are unaware they have it. The annual cost of caring for diabetic patients in Russia is over $12.5 billion.

In the United States, where 29 million people are diabetic, the picture is equally worrisome. One in four people with diabetes doesn’t know that he has the disease. Almost 90 million people are pre-diabetic.

Although figures are not comparable with the situation in Russia, diabetes and its complications in the United States account for $245 billion in total medical costs and lost work and wages.

In addition, a still inadequate health care system, lacking in resources and with attention focused on Russia’s main cities, affects mental health care.

In 2012, there were 277 outpatient clinics devoted to the primary care of people with mental disorders, compared to 318 such clinics in 2005.

At the same time, there has been a reduction in the number and quality of medications for patients with psychiatric illnesses.

Cutting health funding won’t help

Trying to cope with such problems is not easy for Russia. Addressing the underlying challenges would divert increasingly scarce resources from an economy that is under ever-greater strain because of international sanctions and the low price of oil.

Recent cuts in health care and education will not solve the problems affecting the Russian economy. At most, they are palliative measures that may help the budgetary outlook temporarily, but will not cure a sick economy.

Any way out?

The direct connection between the public health crisis and Russia’s economic potential should be clear.

It is estimated that between 2000 and 2010 – well before the recent sanctions – more than 1.25 million Russians emigrated. That represents an even greater number than those who left after the collapse of the Soviet Union.

A survey conducted in June 2012 by the LevadaCenter, an independent pollster, found that one out of every five Russians wants to emigrate compared to one in 20 in 1991, the year the Soviet Union dissolved.

At that time, most emigrants were poor and unskilled. Today, they constitute a wide range of well-off professionals, artists and scientists.

Of course, this generally highly productive group leaves the country largely for reasons having to do with the deteriorating political freedoms in the country.

Failure to tackle Russia’s huge public health problems is likely to exacerbate the brain drain already under way.

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